Provider Demographics
NPI:1982922639
Name:STANDARD MEDICAL SUPPLY, INC.
Entity type:Organization
Organization Name:STANDARD MEDICAL SUPPLY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:J
Authorized Official - Last Name:SCIOLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-328-9767
Mailing Address - Street 1:1101 SUSSEX BLVD
Mailing Address - Street 2:
Mailing Address - City:BROOMALL
Mailing Address - State:PA
Mailing Address - Zip Code:19008-4012
Mailing Address - Country:US
Mailing Address - Phone:610-328-9767
Mailing Address - Fax:610-544-9725
Practice Address - Street 1:95 SPRING RUN ROAD EXT
Practice Address - Street 2:SUITE 410
Practice Address - City:MOON TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:15108-9043
Practice Address - Country:US
Practice Address - Phone:412-424-0062
Practice Address - Fax:412-424-0067
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STANDARD MEDICAL SUPLY, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-05-05
Last Update Date:2010-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA3000007829332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017536420001Medicaid
PA1232790001Medicare NSC